Breaking the Goldwater rule

Readers may be familiar with the American Psychiatric Association’s “Goldwater rule” which says it is unethical to offer a professional opinion about the mental health of a public figure without a personal examination of that person and permission from that person. The rule effectively muzzled these professionals and silenced their opinions of Donald Trump before and since his election to the presidency. One can only wonder whether their opinions might have changed the election results.

Now, however, several of these professionals have decided to speak out about Trump, and if you’ve thought he must be deranged, you now have some professionals who publicly agree with you.

The Dangerous Case of Donald Trump (Bandy Lee, MD, ed) is a collection of 27 essays by psychiatrists and mental health experts.

The prologue states:

“Collectively with our coauthors, we warn that anyone as mentally unstable as Mr. Trump simply should not be entrusted with the life-and-death powers of the presidency.”

Trump displays signs of “extreme present hedonism,” the tendency to live in the moment without considering consequences, seeking to bolster one’s self-esteem no matter the risk. Or he exhibits “narcissistic personality disorder,” which includes believing you’re better than others, exaggerating your achievements and expecting constant praise. Combine hedonism, narcissism and bullying, and you get “an impulsive, immature, incompetent person who, when in the position of ultimate power, easily slides into the role of the tyrant,” Philip Zimbardo (of the famous Stanford prison experiment) and Rosemary Sword write. Others suggest that Trump shows indications of sociopathy, including lack of empathy, absence of guilt and intentional ma­nipu­la­tion. Put it all together and you have “malignant narcissism,” which includes antisocial behavior, paranoid traits, even sadism.

“Mr. Trump’s sociopathic characteristics are undeniable,” retired Harvard psychiatry professor Lance Dodes concludes. “They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism producing more paranoia, more lies, and more enraged destruction.” And when the president stands before the U.N. General Assembly and threatens to “totally destroy” an enemy country of 25 million people, enraged destruction seems on point.

The writers emphasize that they are not, technically, diagnosing the president. “Assessing dangerousness is different from making a diagnosis,” Herman and Lee argue. “Signs of likely dangerousness due to mental disorder can become apparent without a full diagnostic interview.”

The APA will have to decide whether these authors have violated the Goldwater rule, and if so, what’s to be done about it. Frankly, I think when professionals see a potentially dangerous person at large in our society (such as a mentally ill person with a gun), they have the right, if not the obligation, to say something. In most states they do have a Duty to Warn, but only if one of their actual patients poses a risk to others. Perhaps the Goldwater rule needs to be reconsidered. Does it, in fact, deny mental health professionals the right to free speech, the right to state their opinions just like everyone else? (After all, a personal opinion about observed behavior is not a professional diagnosis based on personal interviews and clinical analysis.)

Meanwhile, I applaud the authors for speaking out, if a bit late. And I await Trump’s inevitable tweet about this.

I really have a tough time accepting the free speech thing when it comes to disrespecting the flag and national anthem. If the players (or announcers!) are going to sully my sports events with their political complaints, I’ll watch something else.

Hello,this is John The Cook and you have reviewed my comments before and have acknowledged that I have not violated your rules of conduct in posting my personal opinion. I like your Blog and the people who follow you on a regular basis. That being said, I think members of the organization in the NFL should read their own rules of conduct that ALL players,coaches etc must adhere to weather on or off the field. “T Bow” takes a knee during opening ceremonies and gets ripped by the Liberal left and media,but Kaepernick and others refuses to stand during opening ceremonies and are darn near praised. Talk about a double standard!

Hi John. Didn’t recognize you when you signed in as Anonymous. Sorry, not my intention to block you.
Tebow was kneeling to pray, and I don’t think he did it during the national anthem (but I still didn’t care for such a public display of religiosity). Yesterday really muddied the waters about the kneeling thing. Starting with Kaepernick, it was a protest against cops killing blacks and in support of Black Lives Matter. But yesterday, suddenly, it was a protest against Trump and his recent comments about the NFL. I don’t really care. I don’t want politics mixed with my sports, I think everyone should show proper respect for the flag and the national anthem, and to cap it off, my son told me the the NFL specifically forbids such demonstrations and specifies that players must stand respectfully with their helmets in their left hands. It seems we have massive violations of NFL rules and very selective enforcement of those rules by the NFL.

Frankly I don’t know if all this is double standards, triple standards, or no standards. But if it’s hurting game attendance and viewing, then those players are effectively killing the goose that lays their golden eggs.

The APA is right. Trump is the most unqualified president in U.S. history, no doubt about it. Let’s not forget that he lost the popular vote by 3 million and that he won the electoral college only by demagoguery and help from Russian hackers. We live in an historical turning point and anything can happen, especially when the majority in Congress fail to recognize the reality that confronts them.

These authors are going against the APA, which established the Goldwater rule. I think they are right and the APA is wrong. We needed these voices, these expert opinions, before the election. I don’t know if it would have changed anything, but voices of reason are and have been far too few.

Lots of mistakes before even the nomination — including misguided press focus. I don’t think we needed these professionals to provide unofficial assessments of the candidate’s mental state. Most people who ultimately opposed him that I encountered recognized his deficits and most of the people who supported him, and still do, didn’t care. They discounted such information and had little respect for psych disciplines anyway. Everyone, including me, also much of the media, initially laughed at how ridiculous his even seeking the office was. Many in aligned professional disciplines, such as my own, soon realized he exhibited troublesome behaviors that were often shared by individuals diagnosed with named deficit categories could and may have said as much, but few paid attention. I don’t know that I would support changing the rules as you suggest — the devil would be in the details as do no harm prevails in my mind. He certainly wouldn’t have voluntarily submitted to evaluation as he wouldn’t even release his income tax forms and his supporters didn’t demand it.

Trump played the media like a drum throughout the campaign. They were such patsies for him. They thought his campaign was a big joke and so did I … at first. I’ve thought for years he’s a nut case; why would I take his campaign seriously? Unfortunately, too many people didn’t realize or didn’t care that he’s dangerous.

Changing the Goldwater rule shouldn’t be that hard. The American Psychoanalytic Association has never held its members to it, and American Psychiatric Association members, while still bound by it, are bending it every which way. Yes, there’s the doctor’s “do no harm” but there’s also freedom of speech and opinion. A personal opinion is not professional diagnosis.

Perhaps this book will be a test. Will Trump challenge it — legally or otherwise? Will he be harmed by it? Will the authors be disciplined for publishing it? If nothing happens, the Goldwater rule may just fall of its own weight.